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A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state.
When a state is planning to make a change to its program policies or operational approach, states send state plan amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, or update their Medicaid or CHIP state plan with new information.
Persons with disabilities having problems accessing the SPA PDF files may call 410-786-0429 for assistance.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to waive pharmacy signatures during a portion of the PHE (3/20/20 - 12/15/21).
Summary: The SPA provides an assurance that the State complies with federal minimum requirements regarding medical transportation added by the Consolidated Appropriations Act, 2021. The SPA also clarifies language on the coverage and reimbursement transportation pages to better reflect current
Summary: Annual assurances of the pharmacy program adherence to the requirement of federal regulations regarding expenditures for multiple source drugs.
Summary: This State Plan Amendment includes the following revisions to Certified Community Behavioral Health services:
Removes face-lo-face requirement in order to constitute a visit;
Adds telemedicine and mobile unit as a place of service;
Clarifies definition of crisis intervention;
Updates practitioners who can provide services and also name of practitioner with;
Adds Resident Physician as a qualifying practitioner; and,
Updates rate methodology pages for effective date rate methodology for initial payment rates and for rate reconsiderations, and quality incentive payment.
Summary: Updates prescribing providers for preventive services from only physicians to license practitioners within the scope of their license which is in line with industry standards and federal language.
Summary: Brings state into compliance with third party liability requirements to apply cost avoidance procedures to claims for prenatal services, to make payments to pediatric preventive services without regard to third party liability, and to make payment without regard to third party liability for up to 100 days for claims for child support enforcement to beneficiaries.
Summary: include new Federal requirements that transpo1iation providers and drivers must meet in order to provide Non-emergency Medical Transpo1iation (NEMT) services under the Medicaid program.
Summary: Updates the Primary Care Physician Consultant to the Specialized Healthcare Consultant, allowing Health Homes flexibility in offering additional consultation from a variety of healthcare professions for special populations. Also updates the Per Member Per Month (PMPM) payment for Community Mental Health Centers (CMCH) Health Homes.
